Florence Nightingale Biography PDF

Florence Nightingale: Biography HEALTH - did not define health specifically. Florence Nightingale (12 May 1820 – 13 - She...

Florence Nightingale: Biography HEALTH - did not define health specifically. Florence Nightingale (12 May 1820 – 13 - She stated, “We know nothing of health, the August1910) positive of which pathology is negative, except first nurse theorist well-known for developing for the observation and experience. the Environmental Theory - Nursing should provide care to the healthy founder of modern nursing. and the ill and discussed health promotion as known as “The Lady with the Lamp.”Early Life an activity in which nurses should engage born on May 12, 1820, in Florence, Italy. recognized and agreed that cleanliness From a British family belonged to elite social prevents morbidity (Nightingale, 1999). circles. received her 3-month course at Kaiserswerth Institute in Germany. SUBCONCEPTS OF THE ENVIRONMENTAL THEORY Nightingale’s Environmental Theory The following are the subconcepts of Florence - defined Nursing as “the act of utilizing the Nightingale’s theory: Health of Houses environment of the patient to assist him in his “Badly constructed houses do for the healthy what recovery.” badly constructed hospitals do for the sick. Once - It involves the NURSE’S INITIATIVE to ensure that the air is stagnant and sickness is certain configure environmental settings appropriate to follow.” for the gradual restoration of the patient’s health and that external factors associated with VENTILATION AND WARNING the patient’s surroundings affect the life or - “Keep the air he breathes as pure as the biologic and physiologic processes and his external air, development. - without chilling him.” - person who repeatedly breathed his or her own MAJOR CONCEPTS OF FLORENCE air would become sick or remain sick. NIGHTINGALE'S THEORY - stressed the importance of room temperature. The patient should not be too warm or too NURSING cold. - “What nursing has to do… is to put the patient in the best condition for nature to act upon LIGHT him” (Nightingale, 1859/1992) - Second to fresh air, the sick needed light. - Nightingale stated that nursing “ought to - She noted that direct sunlight was what signify the proper use of fresh air, light, patients wanted. warmth, cleanliness, quiet, and the proper selection and administration of diet – all at the NOISE least expense of vital power to the patient.” - patients should never be “waked intentionally” or accidentally during the first part of sleep. HUMAN BEINGS - She viewed unnecessary noise, including - not defined by Nightingale specifically. noise from the female dress, as cruel and - defined in relation to their environment and the irritating to the patient. impact of the environment upon them. SUBCONCEPTS OF THE ENVIRONMENTAL ENVIRONMENT THEORY - Nightingale used the term SURROUNDINGSin her writing. Variety - She defined and described the concepts of She discussed the need for color and form ventilation, warmth, light, diet, cleanliness, and changes, including bringing the patient brightly noise - components of surroundings colored flowers or plants.  epidemic disease and ill health are being Bed and Bedding installed into the house.” She believed that the bed should be placed in Cleanliness – “the greater part of nursing the lightest part of the room and placed so the consists in preserving cleanliness.” patient could see out of a window. Light (especially direct sunlight) – “the She also reminded the caregiver never to lean usefulness of light in treating disease is very against, sit upon, or unnecessarily shake the important.” patient’s bed.Variety factors posed great significance during She discussed the need for color and form Nightingale’s time when health institutions had changes, including bringing the patient brightly poor sanitation, and health workers had little colored flowers or plants. education and training assessment, documentation, and evaluating its Personal Cleanliness effects on the patient. keep pores of the skin free from all obstructing Deficiencies in these five factors produce excretions.” illness or lack of health, but the body could “Every nurse ought to wash her hands very repair itself with a nurturing environment. frequently during the day.” ASSUMPTIONS OF THE FLORENCE Nutrition and Taking Food NIGHTINGALE’S THEORY individuals desire different foods at different times of the day and that frequent small Florence Nightingale believed that five points servings may be more beneficial to the patient were essential in achieving a healthful house: than a large breakfast or dinner. “pure air, pure water, efficient drainage, She urged that no business be done with cleanliness, and light.” patients while they are eating because this was A healthy environment is essential for healing. a distraction. She stated that “nature alone cures.” Nurses must make accurate observations of Chattering Hopes and Advice their patients and report the state of the patient to falsely cheer the sick by making light of their to the physician in an orderly manner. illness; its danger is not helpful. Nursing is an art, whereas medicine is a She encouraged the nurse to heed what is science. Nurses are to be loyal to the medical being said by visitors, believing that sick plan but not servile. persons should hear the good news that would help them become healthier. VIRGINIA HENDERSON Social Considerations November 30, 1897 – March 19, 1996 Nightingale supported the importance of known for her Need Theory looking beyond the individual to the social Nightingale of Modern Nursing ▪ Modern-Day environment in which they lived. Mother of Nursing The 20th Century Florence Nightingale.” ENVIRONMENTAL FACTORS “The unique function of the nurse is to assist the individual, sick or well, in the performance of those Pure fresh air – “to keep the air he breathes activities contributing to health or its recovery (or to as pure as the external air without chilling him.” peaceful death) that he would perform unaided if he Pure water – “well water of a very impure kind had the necessary strength, will or knowledge.” is used for domestic purposes. - And when the epidemic disease shows VIRGINIA HENDERSON’S NEED THEORY itself, persons using such water are almost sure to suffer.” FOCUSES on the importance of increasing the Effective drainage – “all the while the sewer patient’s independence may be nothing but a laboratory from which  emphasizes the basic human needs and how It is equated with the independence or ability to nurses can assist in meeting those needs. perform activities without any aid in the 14 “I believe that the function the nurse performs components or basic human needs. is primarily an independent one –that of acting nurses are key persons in promoting health, for the patient when he lacks knowledge, preventing illness, and being able to cure. physical strength, or the will to act for himself as he would ordinarily act in health or in NURSING carrying out prescribed therapy. The nurse’s goal is to make the patient - This function is seen as complex and creative, complete, whole, or independent. as offering unlimited opportunity to apply the Nurses temporarily assist an individual who physical, biological, and social sciences and lacks the necessary strength, will, and the development of skills based on them.” knowledge to satisfy one or more of the 14 (Henderson, 1960) basic needs. She states: “The nurse is temporarily the VIRGINIA HENDERSON’S NEED THEORY consciousness of the unconscious, the love life ASSUMPTIONS: for the suicidal, the leg of the amputee, the eyes of the newly blind, a means of locomotion Nurses care for patients until they can care for for the infant, knowledge, and confidence of themselves once again. the young mother, the mouthpiece for those patients desire to return to health. too weak or withdrawn to speak.” Nurses are willing to serve, and that “nurses will devote themselves to the patient day and 14 COMPONENTS OF THE NEED THEORY night.” Henderson also believes that the “mind and Need Theory show a holistic nursing approach body are inseparable and are interrelated.” covering the physiological, psychological, spiritual, and social needs MAJOR CONCEPTS OF THE NURSING NEED THEORY: A. Physiological Components 1. Breathe normally INDIVIDUAL 2. Eat and drink adequately Henderson states that individuals have basic 3. Eliminate body wastes health needs and require assistance to achieve 4. Move and maintain desirable postures health and independence or a peaceful death. 5. Sleep and rest an individual achieves wholeness by 6. Select suitable clothes – dress and undress maintaining physiological and emotional 7. Maintain body temperature within normal range balance. by adjusting clothing and modifying She defined the patient as someone who environment needs nursing care but did not limit nursing to 8. Keep the body clean and well-groomed and illness care. protect the integument 9. Avoid dangers in the environment and avoid ENVIRONMENT injuring others maintaining a supportive environment conducive to health is one of her 14 activities B. Psychological Aspects of Communicating and for client assistance. Learning 10. Communicate with others in expressing emotions, needs, fears, or opinions. 11. Learn, discover, or satisfy the curiosity that HEALTH leads to normal development and health and Although not explicitly defined in Henderson’s use the available health facilities theory, health was taken to mean balance in all realms of human life. C. Spiritual and Moral  12. Worship according to one’s faith It emphasized the give-and-take of nurse-client relationships that was seen by many as D. Sociologically Oriented to Occupation and revolutionary. Recreation Peplau went on to form an interpersonal model 13. Work in such a way that there is a sense of emphasizing the need for a partnership accomplishment between nurse and client as opposed to the 14. Play or participate in various forms of client passively receiving treatment and the recreation nurse passively acting out doctor’s orders. Since there is much similarity, Henderson’s 14 DESCRIPTION components can be applied or compared to Abraham Hildegard E. Peplau’s theory defined Nursing Maslow‘s Hierarchy of Needs. as “An interpersonal process of therapeutic interactions between an individual who is sick 1. Components 1 to 9 are under Maslow’s or in need of health services and a nurse Physiological Needs especially educated to recognize, respond to 2. 9th component is under the Safety Needs. the need for help.” 3. 10th and 11th components are under the Love It is a “maturing force and an educative and Belongingness category instrument” involving an interaction between 4. 12th, 13th, and 14th components are under the two or more individuals with a common goal. Self-Esteem Needs MAJOR CONCEPTS OF THE BIOGRAPHY: Hildegard Peplau INTERPERSONAL RELATIONS THEORY September 1, 1909 – March 17, 1999 The theory explains nursing’s purpose is to help others American nurse who is the only one to serve identify their felt difficulties and that nurses should the American Nurses Association (ANA) as apply principles of human relations to the problems Executive Director and later as President. that arise at all levels of experience. well-known for her Theory of Interpersonal Relations Man - as an organism that “strives in its own way to became known to many as the “Mother of reduce tension generated by needs.” The client is an Psychiatric Nursing” and the “Nurse of the individual with a felt need Century. Health - defined as “a word symbol that implies EDUCATION forward movement of personality and other ongoing In 1931, she graduated from Pottstown, human processes in the direction of creative, Pennsylvania School of Nursing. constructive, productive, personal, and community Peplau earned a Bachelor’s degree in living.” interpersonal psychology in 1943 at Bennington College in Vermont. Society or Environment - Although Peplau does not She studied psychological issues with Erich directly address society/environment, she does Fromm, Frieda Fromm-Reichmann, and Harry encourage the nurse to consider the patient’s culture Stack Sullivan at Chestnut Lodge, a private and mores when the patient adjusts to the hospital psychiatric hospital in Maryland. routine. Peplau held master’s and doctoral degrees from Teachers College, Columbia University, in Nursing - Hildegard Peplau considers nursing to be a 1947. “significant, therapeutic, interpersonal process.” She defines it as a “human relationship between an HILDEGARD PEPLAU’S INTERPERSONAL individual who is sick, or in need of health services, RELATIONS THEORY and a nurse specially educated to recognize and to emphasized the nurse-client relationship as the respond to the need for help.” foundation of nursing practice. THERAPEUTIC NURSE-CLIENT 3. Exploitation Phase - client makes full use of the RELATIONSHIP services offered. A professional and planned relationship Use of professional assistance for between client and nurse focuses on the problem-solving alternatives client’s needs, feelings, problems, and ideas. Advantages of services are used based on the It involves interaction between two or more needs and interests of the patients. individuals with a common goal. The individual feels like an integral part of the The attainment of this goal, or any goal, is helping environment. achieved through a series of steps following a They may make minor requests or attention- sequential pattern. getting techniques. The principles of interview techniques must be FOUR PHASES OF THE THERAPEUTIC used to explore, understand and adequately NURSEPATIENT RELATIONSHIP deal with the underlying problem. Patient may fluctuate on independence. 1. ORIENTATION PHASE - involves engaging the Nurse must be aware of the various phases of client in treatment, providing explanations and communication. information, and answering questions. Nurse aids the patient in exploiting all avenues Problem defining phase of help, and progress is made towards the final It starts when the client meets the nurse as a step stranger. ▪ Defining the problem and deciding the type of service needed 4. Resolution Phase - the client no longer needs Client seeks assistance, conveys needs, asks professional services and gives up dependent questions, shares preconceptions and behavior. expectations of past experiences. relationship ends. Nurse responds, explains roles to the client, Termination of professional relationship identifies problems, and uses available The patient’s needs have already been met by resources and services the collaborative effect of patient and nurse. Sometimes may be difficult for both as psychological dependence persists. The Roles of the Nurse in the Therapeutic Relationship Identified By Peplau: Stranger: offering the client the same acceptance and courtesy that the nurse would respond to any stranger Resource person: providing specific answers to questions within a larger context Teacher: helping the client to learn formally or informally 2. Identification Phase - begins when the client Leader: offering direction to the client or group works interdependently with the nurse, expresses Surrogate: serving as a substitute for another feelings, and begins to feel stronger. such as a parent or a sibling Selection of appropriate professional Counselor: promoting experiences leading to assistance health for the client such as expression of Patient begins to have a feeling of belonging feelings and a capability of dealing with the problem, Technical Expert: providing physical care for which decreases the feeling of the patient and operates equipment HELPLESSNESS AND HOPELESSNESS. Peplau also believed that the nurse could take on many other roles, but these were not defined in detail. However, they were “left to  the intelligence and imagination of the BIOGRAPHY: Joyce Travelbee (1926-1971) readers.” (Peplau, 1952) Born in 1926 in Louisiana Additional roles include: Obtained BSN from Louisiana State University ▪ Technical expert ▪ Safety agent MA at Yale University ▪ Consultant ▪ Manager of environment Psychiatric Nursing Instructor at Depaul ▪ Health teacher ▪ Mediator Hospital Affilliate School, New Orleans. ▪ Tutor ▪ Administrator Detailed her Human-to-Human Relationship in ▪ Socializing agent ▪ Recorder observer her book “Interpersonal Aspects of Nursing”. ▪ Researcher She was influenced by her mentor, Ida Jean Orlando. Anxiety was defined as the initial response to a Her theory was greatly influenced by her psychic threat. experiences in nursing education and practices in Catholic charity institutions. 4 LEVELS OF ANXIETY She concluded that nursing care given to these institutions lacked compassion Mild anxiety is a positive state of heightened awareness and sharpened senses, allowing the HUMAN-TO-HUMAN RELATIONSHIP person to learn new behaviors and solve problems. (METAPARADIGM) The person can take in all available stimuli (perceptual field). Nursing - “is an interpersonal process whereby the professional nurse assists an individual, family, or Moderate anxiety involves a decreased perceptual community to prevent or cope with the existence of field (focus on the immediate task only); illness and suffering, and if necessary, to find meaning the person can learn a new behavior or solve in these experiences” problems only with assistance. Another person can redirect the person to the task. Person - is defined as a human being; both the nurse and patient are human being. A human being is a Severe anxiety involves feelings of dread and terror. unique, irreplaceable individual who is in the The person cannot be redirected to a task; he continuous process of becoming, evolving, and or she focuses only on scattered details and changing. has physiologic symptoms of tachycardia, diaphoresis, and chest pain. Health - is measured by subjective or objective data. Subjective health status is an individually Panic anxiety can involve loss of rational thought, defined state of well-being in accord with delusions, hallucinations, and complete physical self-appraisal of physical-spiritual status immobility and muteness. Objective health is an “absence of discernible The person may bolt and run aimlessly, often disease, disability, or defect as measured by exposing himself or herself to injury. physical examination, laboratory tests, assessment by a spiritual director, or CONCLUSION psychological counselor” Studying Peplau’s Interpersonal Relations Theory of Nursing can be very substantial, Environment especially to aspiring to be part of the was not clearly defined profession. Travelbee defined human conditions and life Knowing the seven nursing roles, future nurses experiences encountered by all men as can apply for different roles in different sufferings, hope, pain, and illness situations, which will guarantee their patients acquire the best care possible and ultimately (Interactional Phases) speed along with treatment and recovery. 1. Original Encounter 2. Emerging Identities 3. Empathy  4. Sympathy the University of California, Los Angeles 5. Rapport (UCLA). Emerging Identities BETTY NEUMAN’S NURSING THEORY The nurse and the patient perceive each other A nursing theory developed by Betty Neuman as unique individuals. is based on the person’s relationship to stress, The link of the relationship begins to form response, and reconstitution factors that are progressive in nature. Empathy presents a broad, holistic, and The ability to share in the person’s experience. system-based method to nursing that Two qualities that enhance the empathy maintains a factor of flexibility. process are similarities of experience and the It focuses on the patient system’s response desire to understand another person to actual or potential environmental stressors Sympathy and maintains the client system’s stability Occurs when the nurse wants to lessen the through primary, secondary, and tertiary cause of the client’s suffering nursing prevention interventions to reduce It goes beyond empathy. stressors. The nurse employs therapeutic use of self. MAJOR CONCEPTS OF NEUMAN SYSTEMS Rapport MODEL Described as nursing interventions that lessen the client’s suffering. Human being The sick person shows trust and confidence in The human being is an open system that the nurse. interacts with internal and external “A nurse is able to establish rapport because environment forces or stressors. she possesses the necessary knowledge and The human is constantly changing, moving skills required to assist all ill persons, and toward a dynamic state of system stability or because she is able to perceive, respond to, illness of varying degrees. and appreciate the uniqueness of the ill human being.” Environment The environment is a vital arena that is Travelbee’s theory extended the interpersonal germane to the system and its function. relationships of Peplau and Orlando (Alligood, may be viewed as all factors that affect and are p35). affected by the system. The theory emphasized the concepts of Three relevant environments: (1) internal, (2) empathy, sympathy, rapport, and emotional external, and (3) created. aspects of nursing and updated it with a 1. internal environment exists within the client reminder that compassion is central to holistic system. All forces and interactive influences nursing care. that are solely within the client system’s The hospice is one good example in which boundaries make up this environment. Travelbee’s theory is applied. 2. external environment exists outside the client system. Biography of Betty Neuman 3. created environment is unconsciously born in 1924 near Lowell, Ohio. developed and is used by the client to support engaged and fascinated with the study of protective coping. human behavior. 1947, she received her RN Diploma from Health Peoples Hospital School of Nursing, Akron, defined as the condition or degree of system Ohio. stability and is viewed as a continuum from She also earned a master’s degree in mental wellness to illness. health, public health consultation in 1966 from  When system needs are met, optimal wellness 1. physiological variable refers to the structure exists. and functions of the body. When needs are not satisfied, illness exists. 2. psychological variable refers to mental When the energy needed to support life is not processes and relationships. available, death occurs. 3. sociocultural variable refers to system functions that relate to social and cultural Nursing expectations and activities. Nursing’s primary concern is to define the 4. developmental variable refers to those appropriate action in situations that are processes related to development over the stressrelated or concerning possible reactions lifespan. of the client or client system to stressors. 5. spiritual variable refers to the influence of Nursing interventions aim to help the system spiritual beliefs. adapt or adjust and retain, restore, or maintain 6. Flexible line of defense - A protective some degree of stability between the client accordion-like mechanism that surrounds and system variables and environmental stressors, protects the normal line of defense from focusing on conserving energy. invasion by stressors. 7. Normal line of defense - An adaptational level of health developed over time and is considered normal for a particular individual client or system; it becomes a standard for wellness-deviance determination. 8. Lines of resistance - Protection factors are activated when stressors have penetrated the normal line of defense, causing reaction symptomatology Subconcepts of Neuman Systems Model Stressors - is any phenomenon that might penetrate both the flexible and normal lines of defense, resulting in either a positive or negative outcome. Open System 1. Intrapersonal stressors are those that occur A system in which there is a continuous flow of within the client system boundary and correlate input and process, output and feedback. with the internal environment. It is a system of organized complexity, where 2. Interpersonal stressors occur outside the all elements are in interaction. client system boundary, are proximal to the system, and impact the system. Basic Structure and Energy Resources 3. Extrapersonal stressors also occur outside The basic structure, or central core, comprises the client system boundaries but are at a those basic survival factors common to the greater distance from the system than are species. interpersonal stressors. An example is a social These factors include the system variables, policy. genetic features, and strengths and weaknesses of the system parts. Stability - A state of balance or harmony requiring energy exchanges as the client adequately copes with Client Variables stressors to retain, attain, or maintain an optimal health level, thus preserving system integrity. Neuman views the individual client holistically and considers the variables simultaneously and Degree of Reaction - The amount of system comprehensively. instability resulting from stressor invasion of the normal line of defense. Entropy - A process of energy depletion and TERTIARY PREVENTION disorganization moving the system toward illness or occurs after the system has been treated possible death. through secondary prevention strategies. Its purpose is to maintain wellness or protect Negentropy - An energy conservation process that the client system reconstitution by supporting increases organization and complexity, moving the existing strengths and preserving energy. system toward stability or a higher degree of wellness. may begin at any point after system stability has begun reestablished (reconstitution has Input/Output - The matter, energy, and information begun). exchanged between the client and environment entering or leaving the system at any point in time. Faye Glenn Abdellah (March 13, 1919 – February 24, 2017) Reconstitution - Following treatment of stressor a nursing research pioneer reaction, the return and maintenance of system developed the “Twenty-One Nursing stability may result in a higher or lower wellness level. Problems.” earned a nursing diploma from Fitkin Memorial PREVENTION AS INTERVENTION Hospital’s School of Nursing, now known as NIntervention modes for nursing action and Ann May School of Nursing. determinants for both client and nurse entry earn three degrees from Columbia University: into the healthcare system. a bachelor of science degree in nursing in 1. Primary prevention 1945, 2. Secondary prevention a master of arts degree in physiology in 1947 3. Tertiary prevention a doctor of education degree in 1955. It was sufficient to practice nursing during her PRIMARY PREVENTION time in the 1940s, but she believed that occurs before the system reacts to a stressor; nursing care should be based on research, not it includes health promotion and wellness hours of care. maintenance. focuses on strengthening the flexible line of ABDELLAH’S 21 NURSING PROBLEMS defense through preventing stress and THEORY reducing risk factors. This intervention occurs when the risk or According to Abdellah’s theory, “Nursing is based hazard is identified but before a reaction on an art and science that molds the attitudes, occurs. intellectual competencies, and technical skills of the Strategies that might be used include individual nurse into the desire and ability to help immunization, health education, exercise, and people, sick or well, cope with their health needs.” lifestyle changes. PATIENT - CENTERED APPROACH to nursing was SECONDARY PREVENTION developed from Abdellah’s practice occurs after the system reacts to a stressor and is provided in terms of existing symptoms. 21 NURSING PROBLEMS THEORY focuses on strengthening the internal lines of It was formulated to be an instrument for resistance and, thus, protects the basic nursing education structure through appropriate treatment of intended to guide care in HOSPITAL symptoms. INSTITUTIONS but can also be applied to The intent is to regain optimal system stability community health nursing. and conserve energy in doing so. If unsuccessful and reconstitution does not occur, the basic structure will be unable to support the system and its interventions, and death will occur. MAJOR CONCEPTS OF 21 NURSING ABDELLAH’S 21 NURSING PROBLEMS ARE PROBLEMS THEORY THE FOLLOWING: 1. To maintain good hygiene and physical The model has interrelated concepts of health and comfort. nursing problems and problem-solving, which is 2. To promote optimal activity: exercise, rest, inherently logical in nature. sleep 3. To promote safety by preventing accidents, INDIVIDUAL injuries, or other trauma and preventing the recipients of nursing care (and families) spread of infection. HEALTH 4. To maintain good body mechanics and prevent Health, achieving it, is the purpose of nursing and correct the deformity. services. 5. To facilitate the maintenance of a supply of she speaks to “total health needs” and “a oxygen to all body cells. healthy state of mind and body.” 6. To facilitate the maintenance of nutrition for all SOCIETY body cells. Society is included in “planning for optimum 7. To facilitate the maintenance of elimination. health on local, state, and international levels.” 8. To facilitate the maintenance of fluid and focus of nursing service is clearly the electrolyte balance. individual. 9. To recognize the physiologic responses of the NURSING PROBLEMS body to disease conditions— pathologic, The client’s health needs can be viewed as physiologic, and compensatory. problems, overt as an apparent condition, or 10. To facilitate the maintenance of regulatory covert as a hidden or concealed one. mechanisms and functions. Problem Solving 11. To facilitate the maintenance of sensory Quality professional nursing care requires that function. nurses be able to identify and solve overt and 12. To identify and accept positive and negative covert nursing problems. expressions, feelings, and reactions. The problem-solving process can meet these 13. To identify and accept interrelatedness of requirements by: emotions and organic illness. 1. identifying the problem, 14. To facilitate the maintenance of effective verbal 2. selecting pertinent data, and nonverbal communication. 3. formulating hypotheses, 15. To promote the development of productive 4. testing hypotheses through collecting interpersonal relationships. data, 16. To facilitate progress toward achievement and 5. revising hypotheses when necessary personal spiritual goals. based on conclusions obtained from 17. To create or maintain a therapeutic the data. environment. 18. To facilitate awareness of self as an individual SUBCONCEPTS: 21 NURSING PROBLEMS with varying physical, emotional, and THEORY developmental needs. 19. To accept the optimum possible goals in the Abdellah’s Typology of 21 Nursing Problems light of limitations, physical and emotional. 21 nursing problems fall into categories: 20. To use community resources as an aid in physical, sociological, and emotional needs of resolving problems that arise from an illness. patients; types of interpersonal relationships 21. To understand the role of social problems as between the patient and nurse; and common influencing factors in the cause of illness. elements of patient care. She used Henderson’s 14 basic human needs ACCORDING TO ABDELLAH AND and nursing research to establish the COLLEAGUES (1960), NURSES SHOULD DO classification of nursing problems. THE FF: Learn to know the patient.  Sort out relevant and significant data. and connect among themselves and their Make generalizations about available data in environment. relation to similar nursing problems presented 2. The power to act deliberately is exercised to by other patients. identify needs and to make needed judgments. Identify the therapeutic plan. 3. Mature human beings experience privations in Test generalizations with the patient and make the form of action in care of self and others additional generalizations. involving making life- sustaining and Validate the patient’s conclusions about his or function-regulating actions her nursing problems. 4. Human agency is exercised in discovering, Continue to observe and evaluate the patient developing, and transmitting to others ways over a period of time to identify any attitudes and means to identify needs for, and make and clues affecting his or her behavior. inputs into, self and others. Explore the patient’s and family’s reaction to 5. Groups of human beings with structured the therapeutic plan and involve them in the relationships cluster tasks and allocate plan. responsibilities for providing care to group Identify how the nurse feels about the patient’s members. nursing problems. Discuss and develop a comprehensive nursing MAJOR CONCEPTS care plan. Nursing is as art through which the Dorothea Orem practitioner of nursing gives specialized July 15, 1914 – June 22, 2007 assistance to persons with disabilities which was one of America’s foremost nursing makes more than ordinary assistance theorists necessary to meet needs for self-care. developed the Self-Care Deficit Nursing Humans are defined as “men, women, and Theory, also known as the Orem Model of children cared for either singly or as social Nursing. units,” and are the “material object” of nurses She went on to the Catholic University of and others who provide direct care. America to earn a B.S. in Nursing Education in Environment has physical, chemical and 1939 and an M.S. in Nursing Education in biological features. It includes the family, 1945. culture and community. She had a distinguished career in nursing. She Health is “being structurally and functionally earned several Honorary Doctorate degrees. whole or sound.” Also, health is a state that encompasses both the health of individuals SELF – CARE THEORY and of groups, and human health is the ability to reflect on one’s self, to symbolize Dorothea Orem’s Self-Care Deficit Theory focuses experience,and to communicate with others. on each “individual’s ability to perform self-care, Self-Care - the performance or practice of defined as ‘the practice of activities that individuals activities that individuals initiate and perform initiate and perform on their own behalf in maintaining on their own behalf to maintain life, health, and life, health, and wellbeing.’ well- being. Major Concepts Self-Care Agency - the human’s ability or composed of three interrelated theories: power to engage in self-care and is affected by 1. the theory of self-care basic conditioning factors. 2. the self-care deficit theory Therapeutic Self-care Demand is the totality 3.the theory of nursing systems of “self-care actions to be performed for some duration to meet known self-care requisites by ASSUMPTIONS OF DOROTHEA‘S SELF-CARE using valid methods and related sets of actions THEORY and operations.” 1. In order to stay alive and remain functional, 1. age, gender, developmental state humans engage in constant communication 2. health state, health care system factors, 3. socio-cultural orientation, family system factors, 2. DEVELOPMENTAL SELF-CARE REQUISITES: 4. patterns of living, environmental factors, and resource adequacy and availability. Normalcy is used in the sense of that which is essentially human and that which is in accord with the Self-Care Deficit - delineates when nursing is genetic and constitutional characteristics and needed. individuals’ talents. Nursing Agency - is a complex property or attribute of people educated and trained as “either specialized expressions of universal self-care nurses that enables them to act, know, and requisites that have been particularized for help others meet their therapeutic self-care developmental processes or they are new requisites demands by exercising or developing their own derived from a condition or associated with an event.” self-care agency. Nursing System - the product of a series of 3. HEALTH DEVIATION SELF – CARE REQUISITES relations between the persons: legitimate - are required in conditions of illness, injury, or nurse and legitimate client. disease or may result from medical measures system is activated when the client’s required to diagnose and correct the condition. therapeutic self-care demand exceeds Seeking and securing appropriate medical the available self-care agency, leading assistance. to nursing. Being aware of and attending to the effects and results of pathologic conditions and states THEORY OF SELF-CARE Effectively carrying out medically prescribed diagnostic, therapeutic, and rehabilitative FOCUSES : the performance or practice of activities measures. that individuals initiate and perform on their own behalf Being aware of and attending to or regulating to maintain life, health, and wellbeing. the discomforting or deleterious effects of prescribed medical measures Self-care Requisites or requirements can be Modifying the self-concept (and self-image) in defined as actions directed toward the provision of accepting oneself as being in a particular state self-care. It is presented in three categories: of health and in need of specific forms of 1. Universal Self-Care Requisites health care 2. Developmental self-care requisites Learning to live with the effects of pathologic 3. Health deviation self-care requisites conditions and states and the effects of medical diagnostic and treatment measures in 1. UNIVERSAL SELF-CARE REQUISITES a lifestyle that promotes continued personal - associated with life processes and the development maintenance of the human structure and functioning integrity. THEORY OF SELF-CARE DEFICIT The maintenance of a sufficient intake of air Delineates when nursing is needed The maintenance of a sufficient intake of water Nursing is required when an adult (or in the The maintenance of a sufficient intake of food case of a dependent, the parent or guardian) is elimination process and excrements incapable of or limited in providing continuous The maintenance of a balance between activity effective self-care. and rest The maintenance of a balance between Orem identified 5 methods of helping: solitude and social interaction 1. Acting for and doing for others The prevention of hazards to human life, 2. Guiding others human functioning, and human well-being 3. Supporting another The promotion of human functioning and 4.Providing an environment promoting personal development within social groups in accord development about meet future demands with human potential, known human 5.Teaching another limitations, and the human desire to be normal THEORY OF NURSING SYSTEM - She developed the Goal Oriented nursing record (GONR). Wholly Compensatory Nursing System - Retired in 1990. a situation in which the individual is unable “to engage in those self-care actions requiring self-directed and (METAPARADIGM) controlled ambulation and manipulative movement or the medical prescription to refrain from such activity NURSING Persons with these limitations are socially - “Nursing is an observable behavior found in dependent on others for their continued the health care systems in society” (King, existence and well-being.” 1971, p. 125) - The goal of nursing “is to help individuals Example: care of a newborn, care of client recovering maintain their health so they can function in from surgery in a post-anesthesia care unit their roles” (King, 1981, pp. 3– 4) - “Nursing is a process of action, reaction, and Partial Compensatory Nursing System interaction whereby nurse and client share represented by a situation in which “both nurse and information about their perceptions in the perform care measures or other actions involving nursing situation”. manipulative tasks or ambulation… [Either] the patient - The goal of nursing “is to help individuals or the nurse may have a major role in the performance maintain their health so they can function in of care measures.” their roles” (King, 1981, pp. 3–4) Example: PERSON Nurse can assist the postoperative client in Assumptions Related to Persons: ambulating - Individuals are spiritual beings (I. King, Nurse can bring a meal tray for a client who personal communication, July 11, 1996). can feed himself - Individuals have the ability through their language and other symbols to record their Supportive-Educative System history and preserve their culture (King, 1986) also known as a supportive-developmental system. - Individuals are unique and holistic, of intrinsic person “can perform or can and should learn to worth, and capable of rational thinking and perform required measures of externally or internally decision making in most situations (King, oriented therapeutic self-care but cannot do so without 1995b). assistance.” - Individuals differ in their needs, wants, and goals (King, 1995b Example: Nurse guides a mother on how to breastfeed her baby, Counseling a psychiatric client on HEALTH more adaptive coping strategies. - Health is a dynamic state in the life cycle, whereas illness interferes with that process. Imogene King (1923-2007) - Health “implies continuous adjustment to (Goal Attainment Theory) stress in the internal and external environment through the optimum use of one’s resources to “ If the students can’t do Fundamentals, how can they achieve the maximum potential for daily living” use advanced knowledge?” (King, 1981, p. 5) - Earned her BS in nursing in St. Louis Missouri ENVIRONMENT in 1948. - The process of balance involving internal and - Worked as an instructor in Medical-surgical external interactions inside the social system. nursing and assistant director at St. John’s - King (1981) believed that “an understanding of Hospital of Nursing. the ways that human beings interact with their - Also served as research coordinator at the environment to maintain health was essential Loyola Medical Center. for nurses” (p. 2).  In addition, nurses interact with family DOMAIN OF NURSING members when clients cannot verbally participate in the goal setting.” (1995b, p. 28) 1. Personal System King designated an example of a personal TRANSACTION system as a patient or a nurse. - A process of interaction in which human beings King specified the concepts of body image, communicate with the environment to achieve growth and development, perception, self, goals that are valued and goal directed human space, and time to comprehend human beings behaviors. as persons. HYPOTHESES OF GOOD ATTAINMENT THEORY 2. Interpersonal System 1. Perceptual accuracy in nurse-patient Interpersonal systems form when two or more interactions increases mutual goal setting. individuals interact, forming dyads (two people) 2. Communication increases mutual goal setting or triads (three people) between nurses and patients and leads to The dyad of a nurse and a patient is one type satisfaction. of interpersonal system. 3. Satisfactions in nurses and patients increase Families, when acting as small groups, also goal attainments. can be considered interpersonal systems. 4. Goal attainment decreases stress and anxiety in nursing situations. 3. Social System 5. Goal attainment increases patient learning A more comprehensive interacting system and coping ability in nursing situations. consists of groups that make up society. 6. Role conflict experienced by patients, nurses, Religious, educational, and health care or both decreases transactions in nurse-patient systems are examples of social systems interactions. 7. Congruence in role expectations and role Interacting System Framework performance increases transactions in nurse-patient interactions DOROTHY JOHNSON (1919-1999) (Behavioral System Model) - Her work was inspired by Florence Nightingale. - Nightingale’s philosophical leanings prompted Johnson to consider the person experiencing a disease more important than the disease itself (Johnson, 1990) METAPARADIGM NURSING - Nursing is seen as “an external regulatory MUTUAL GOAL SETTING force which acts to preserve the organization and “Mutual goal setting [between a nurse and a integration of the patient’s behavior at an optimal level client] is based on under those conditions in which the behavior “Mutual goal setting [between a nurse and a constitutes a threat to physical or social health, or in client] is based on which illness is found” (Johnson, 1980, p. 214) nurses’ and clients’ perceptions of the interference; and their sharing of information PERSON (HUMAN) - The concept of human was whereby each functions to help the client attain defined as a behavioral system that strives to make the goals identified. continual adjustments to achieve, maintain, or regain balance to the steady state that is adaptation (Johnson, 1980).  7 SUBSYSTEM HEALTH - Health is seen as the opposite of illness, and Johnson (1980) defines it as “some degree of 1. ATTACHMENT OR AFFILIATIVE regularity and constancy in behavior, the behavioral It provides survival and security. system reflects adjustments and adaptations that are Its consequences are social inclusion, intimacy, successful in some way and to some degree … and formation and maintenance of a strong adaptation is functionally efficient and effective” social bond (Johnson, 1980) ENVIRONMENT - Environment is not directly defined, 2. DEPENDENCY but it is implied to include all elements of the the dependency subsystem promotes helping surroundings of the human system and includes behavior that calls for a nurturing response. interior stressors. Its consequences are approval, attention or recognition, and physical assistance. MAJOR CONCEPTS A certain amount of interdependence is essential for the survival of social groups Behavioral system - man is a system that indicates (Johnson, 1980) the state of the system through behavior. 3. INGESTIVE SYSTEM Boundaries - the point that differentiates the interior Has something to do with when, how, what, of the system from the exterior. how much, and under what conditions we eat” (Johnson, 1980, p. 213). Function - consequences or purposes of actions “It serves the broad function of appetitive satisfaction” (Johnson, 1980, p. 213). Functional requirements - input that the system must receive to survive and develop 4. ELIMINATIVE SYSTEM addresses “when, how, and under what Homeostasis - the process of maintaining stability conditions we eliminate” (Johnson, 1980, p. 213). Instability - the state in which the system output of energy depletes the energy needed to maintain 5. SEXUAL stability This subsystem has the dual functions of procreation and gratification. Stability - balance or steady state in maintaining Including, but not limited to, courting and balance of behavior within an acceptable range mating, this response system begins with the development of gender role identity and Stressor - stimulus from the internal or external world includes the broad range of sex-role behaviors that results in stress or instability (Johnson, 1980). Structure - the parts of the system that make up the 6. ACHIEVEMENT SUBSYSTEM whole attempts to manipulate the environment. Its function is control or mastery of an aspect Subsystem - a minisystem maintained in relationship of self or environment to some standard of to the entire system when it or the environment is not excellence. disturbed. Areas of achievement behavior include intellectual, physical, creative, mechanical, and Tension - the system’s adjustment to demands, social skills (Johnson, 1980). change or growth, or to actual disruptions Variables - factors outside the system that influence 7. AGGRESSIVE-PROTECTIVE the system’s behavior, but which the system lacks The aggressive-protective subsystem’s power to change function is protection and preservation. 3 FUNCTIONAL REQUIREMENTS OF HUMANS ❑ Unitary human being (human field) - an IN JOHNSON’S (1980) MODEL irreducible, indivisible, pandimensional energy filed identified by patter and manifesting characteristics that 1. To be protected from noxious influences with are specific to the whole and that cannot be predicted which the person cannot cope. from knowledge of the parts. 2. To be nurtured through the input of supplies ❑ Environmental Field - an irreducible, from the environment. pandimensional energy field identified by pattern and 3. To be stimulated to enhance growth and integral with the human field. Although not necessarily prevent stagnation quantifiable, an energy field has the inherent ability to create change. Martha Rogers (1914-1994) (Science of Unitary Human Beings) ❑ Universe of Open Systems - holds that energy - Born on May 12, 1914, in Dallas, Texas fields are infinite, open, and integral with one another; - Received her nursing degree in George the human and environmental fields are in continuous Peabody College in Nashville, Tennessee in process and are open systems. 1937. - She had master’s degrees in public health ❑ Pattern - identifies energy fields; the distinguishing nursing supervision and public arts degrees, characteristic of an energy field and is perceived as a and a doctor of science degree. single wave the nature of pattern changes - Her early nursing practice was in rural public continuously and innovatively, and these changes give health nursing and in visiting nurse identity to the energy field. supervision, education, and practice. - She established the Visiting Nurse Service of ❑ PANDIMENSIONALITY - a nonlinear domain Phoenix, Arizona. without spatial or temporal attributes “essentially a - She was a professor and head of the Division spaceless and timeless reality” (Philips, 2010) an of Nursing at New York University and was a infinite domain without limit Professor Emerita until her death in 1994. - Her publications include three books and more (METAPARADIGM) than 200 articles. - Rogers credited scientists from multiple NURSING disciplines with influencing the development of - is a learned profession and is both a science the SCIENCE OF UNITARY HUMAN BEINGS and an art. (SUBH). - an empirical science and lies in the - Rogerian Science emerged from the phenomenon central to its focus knowledge bases of anthropology, astronomy, - Rogerian nursing focuses on concern with religion, philosophy, history, biology, physics, people and the world which they live. mathematics, and literature. - the purpose of nursing is to promote health and wellness for all persons (Major Concepts and Assumptions) - “Professional practice in nursing seeks to promote symphonic interaction between - four buildings blocks of SUBH: human and environmental fields, to strengthen - Energy field the integrity of human field, and to direct and - A universe of open systems redirect patterning of the human and - Pattern environmental fields for realization of maximum - Four-dimensionality (pandimensionality) health potential” (Rogers, 1970, p. 122). ❑ ENERGY FIELD - constitutes the fundamental unit of both the living and the non-living. Energy fields are PERSON infinite and pandimensional. Two fields identified are: - an open system in continuous process with the humanitary human field and the environmental field. open system that is the environment. - A “UNITARY HUMAN BEING is an irreducible, indivisible, pandimensional energy field  identified by pattern and manifesting nursing practice in the late 1950s during her characteristics that are specific to the whole” doctoral work in anthropology. (Rogers, 1992, p. 29) - “Care is the essence of nursing and a distinct, - “MAN is a unified whole processing his own dominant, central and unifying focus.” integrity and manifesting characteristics that Madeleine Leininger (Leininger & McFarland, are more than and different from the sum of his 2002, p. 192) parts” (Rogers, 1970) - “The purpose of Leininger’s theory is to generate knowledge related to the nursing care HEALTH of people who value their cultural heritage and lifeways” - no clear definition - Roger used the term passive health to MAJOR CONCEPTS symbolize - wellness and the absence of major illness Care refers to abstract and manifest phenomena with - her promotion of health connotes direction expressions of assistive, supportive, enabling, and - in helping people with opportunities for facilitating ways toward or about self or others. rhythmic consistency (Rogers, 1970). Caring refers to actions, attitudes, or practices to SISTER CALLISTA ROY (1939) assist others toward healing and well-being (ADAPTATION MODEL) Generic care refers to the learned and transmitted lay, - The Roy Adaptation Model (RAM) focuses on indigenous, traditional or local folk (emic) knowledge the interrelatedness of four adaptive systems. and practices to provide assistance, supportive, enabling, and facilitative acts for or toward others with METAPARADIGM evident or anticipated health needs in order to improve wellbeing or to help with dying or other human NURSING - is the science and practice that expands conditions” (McFarland & Wehbe-Alamah, 2015, p. 14) adaptive abilities and enhances person and Professional nursing care refers to formal and environment transformation. Roy’s goal of nursing is explicit cognitively learned professional care the promotion of adaptation in each of the four knowledge and practices obtained generally through models, thereby contributing to the person’s health, educational institutions [usually nongeneric] [that] are taught to nurses and others to provide assistive, quality of life and dying with dignity. supportive, enabling, or facilitative acts for or to another individual or group in order to improve their PERSON - Sister Roy viewed the person as a health, prevent illnesses, or to help with dying or other human conditions” (McFarland & Wehbe-Alamah, biopsychosocial being in constant interaction with a 2015, p. 14) changing environment - the person is an open, adaptive system who uses coping skills to deal with stressors - it includes people as individuals or in groups HEALTH - is the process of being and becoming an integrated and whole person - Adaptation is defined as the process and outcome whereby thinking and feeling, as individuals and in groups, use conscious awareness and choice to create human and Culturally congruent care is culturally based care environmental integration knowledge, acts, and decisions used in sensitive, ENVIRONMENT - conditions, circumstances, and creative, and meaningful ways to appropriately fit the influences that surround and affect the development cultural values, beliefs, and lifeways of clients for their health and wellbeing, or to prevent or face illness, and behavior of the person disabilities, or death. MADELEINE LEININGER (1925-2012) “The provision of culturally congruent and safe care has been the major goal of the culture care theory” (THEORY OF CULTURE CARE DIVERSITY AND (McFarland & Wehbe-Alamah, 2015, p. 14) UNIVERSALITY) - Leininger reported that she conceptualized Culture care universality - refers to commonly transcultural nursing as a distinct area of shared or similar cultural care phenomena features of human beings or groups with recurrent meanings, - Environmental framework is defined as being patterns, values, symbols, or lifeways that serve as a the totality of an event, situation, or guide for caregivers to provide assistive, supportive experience. facilitative, or enabling people care for healthy - also a worldview, social structure, and outcomes” (McFarland & WehbeAlamah, 2015, p. 15). environmental context. Culture care preservation or maintenance refers to assistive, supportive, facilitative, or enabling professionalactions and decisions that help people of a particular culture to retain, preserve, or maintain meaningful care beliefs and values for their well-being, to recover from illness, or to deal with handicaps or dying (Leininger 1991, 1995; Leininger & McFarland, 2002, 2006; McFarland & Wehbe-Alamah, 2015). Culture care accommodation or negotiation refers to those assistive, accommodating, facilitative, or enabling creative professional care actions and decisions that help people of a designated culture (or subculture) to adapt to or negotiate with others for culturally congruent, safe, effective care for meaningful and beneficial health outcomes (Leininger 1991, 1995; Leininger & McFarland, 2002, 2006; McFarland & Wehbe-Alamah, 2015) Culture care repatterning or restructuring refers to the assistive, supportive facilitative, or enabling professional actions and decisions that help clients reorder, change, or modify their lifeways for beneficial health care patterns, practices, or outcomes (Leininger 1991, 1995; Leininger & McFarland, 2002, 2006; McFarland & Wehbe-Alamah, 2015) METAPARADIGM NURSING - Proposed 3 types of nursing care that are culturally-based and thus consistent with the needs and values of the clients. - These are cultural care preservation/maintenance, cultural care accommodation/negotiation, and cultural care repatterning and restructuring. PERSON - Human beings are believed to be caring and capable of being concerned about the desires, welfare, and continued existence of others. HEALTH - Health is seen as universal across cultures but distinct within each culture that represents the beliefs, values, and practices of the particular culture. - Health is both universal and diverse ENVIRONMENT